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(Name of Licensee) PURCHASED OR RECEIVED FROM INVOICE DATE INVOICE NUMBER OLCC LICENSE NUMBER NAME MALT BEVERAGE/CIDER BARRELS Total Number of Barrels (To Line 1 Statement) (and Line 2 of inventory Sch 7) (To Column A) THIS SCHEDULE MUST BE FILED IN DUPLICATE PT 1 (Rev 11/07) (See Instructions on Reverse Side) INSTRUCTIONS PRIVILEGE TAX SCHEDULE 1 All manufacturers and Importers of Malt Beverages must prepar.

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